Mr. Dhanasekaran S 1/256-C AMMAN KOVILPATTI Virudhungar VIRUDHUNAGAR, 626005 Tamil Nadu Contact No: 97XXXXXXX1 Date: 01/04/2024

HDFC ERGO General Insurance Company Limited 2811206280381100000
2811206280381100000
MR. DHANASEKARAN S
1/256-C AMMAN KOVILPATTI Virudhungar VIRUDHUNAGAR, 626005
TAMIL NADU
Contact No : 97XXXXXXX1
Date : 01/04/2024
We welcome you to be a part of our family!
Your Health insurance certificate no. 2811206280381100000 is confirmed on the basis of the information and declaration given by you.The details of coverage are mentioned in
the enclosed Certificate of insurance.
As a measure of our customer convenience we have implemented a Lifetime Validity Health Card. For you, this simply means that your Health Card is valid for all subsequent
renewals and as long as your policy is active with us. Hence, you need not replace your health card every year.
We value your relationship with us and assure you our best services at all times and we look forward to serve you.
Proposer details have been updated basis the information present in the KYC documents. If you find any detail which needs to be corrected, request you to create/ modify the
eKYC ID and place a request for endorsement.
Soft copy of the policy is valid for all purposes including claims.
For HDFC ERGO General Insurance Company Ltd.
Arun Sharma
Head - Customer Experience Management
HDFC ERGO General Insurance Company Limited

TAX CERTIFICATE
Dear MR. Dhanasekaran S,

Subject : Certificate for the purpose of deduction under section 80 D of Income Tax (Amendment) Act, 1986
This is to certify that we have received an amount of ` 7258 towards premium Certificate of Insurance 2811206280381100000 issued to MR. DHANASEKARAN S for the
period 31/03/2024 to 30/03/2025.
Note : This is subject to the provisions of Section 80D of income tax (Amendment) Act, 1986 as amended from time to time.
For HDFC ERGO General Insurance Company Ltd.
Date : 01/04/2024
Policy Issuing Office: Mumbai
Duly Constituted Attorney
HDFC ERGO General Insurance Company Limited. IRDAI Reg No.146 UIN : HDFHLGP21116V012021. Customer Service Address: D 301, 3rd Floor,
CIN : U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.
165/166 Backbay Reclamation, H.T.Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service No : +91 22-62346234/+91-120 6234 6234 | www.hdfcergo.com
Certificate of Insurance
HDFC Group Health Insurance
2811206280381100000
Certificate No. . :2811 2062 8038 1100 000 Issuance Date :01/04/2024
Period of Insurance :From 31/03/2024 10:07 hrs To 30/03/2025 Midnight
Invoice No. :206280381100000 Policy Type :Individual
Proposer Name :Mr. Dhanasekaran S Premium Frequency :Single
MR. DHANASEKARAN S
0
1/256-C AMMAN KOVILPATTI Virudhungar VIRUDHUNAGAR HSN Code :997133 Plan Type: :Gold
TAMIL NADU, 626005 Customer Id :1002803887140003 Pan No.
Contact No : 97XXXXXXX1
Name of the Policy
:HDFC BANK Customer UIN:
Holder:
Master Policy No :2999204608551801000
Payment Details : 91124033100014 , Bank Name :BIZDIRECT

Email ID : dhxxxxxxxxxxan@gxxxx.com
Insured Person’s Details & Sum Insured In (`)
Insured's Name Relation with Gender Date of Nominee Name Nominee 1st Policy Sum CB Pre-existing
policy holder Birth Relationship Inception Insured Amount disease
Dhanasekaran S Self Male 04/06/1992 Yamuna D Spouse 31/03/2024 500000 0 No
The nominee must be an immediate relative of the policyholder. For all other Insured Persons the policy holder shall be the nominee
Coverage Details
Coverage Details Coverage Details
In-Patient Hospitalisation Covered Pre-Hospitalization Medical Expenses Cover 60
1% of Sum Insured,Max Rs.
Post-Hospitalization Medical Expenses Cover 90 Room Rent Per Day (Normal)
3,000/-
Room Rent Per Day (ICU) 2% of Sum Insured Road Ambulance Cover Rs. 2,000/- per hospitalization
30 Day Waiting Period Applicable Waiting period for specified illnesses 24 Months
Waiting Period for Pre-existing Diseases 36 Months Day Care Procedures Covered
Domiciliary Hospitalization Covered Alternative Treatment Upto 50% of Sum Insured
1% of Sum Insured, max Rs.
Preventive Health Check-up Organ Donor Expenses Covered
2,000/- in a block of 3 years
10% for each claim free year, max
Cumulative Bonus Disease Capping None
50%
Restore Benefit Not Applicable Hospital Cash Rs. 500 per day, max 30 days
Please refer Policy wordings for all the standard coverage offered b y the Company to its customers. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits a s mentioned in this Certificate
of Insurance. Policy wordings are available at www.hdfcergo.com
• Room rent per day – Room rent and all other related charges covered in accordance with room rent restriction o r actual, whichever i s less. In the event of a person getting admitted in higher category, the related
charges will be pro-rated to the eligible room rent limit. All other related charges will among other things include OT Charges, Doctors Charges, Nursing charges, Diagnostics and the same will be payable a s per
room rent entitlement.
• Life Long Renewability- As long as master policy is renewed with us and proposer continues to be member of the group
Premium Details (`)
Basic Premium (A) 6,151.00
Medical Underwriting Loading (B) 0.00
Total Premium (A+B) 6,151.00
Integrated Tax 18 % 1,107.00
Gross Premium 7,258.00
Applicable only to HDFC BANK Customers

Entry Age – 18 years to 65 years, Dependent child – 3 months to 25 years
(Please refer to the Master Policy issued to and available with HDFC BANK Customers for full particulars and details)
Special Conditions :Age proof/identity proof will be collected in event of claim under the policy.
For Claim/Policy related queries call us at +91- 22 6234 6234/+91- 120 6234 6234 or Visit Help Section on www.hdfcergo.com for policy copy/tax certificate/make changes/register & track claim.
If the premium is not realised the policy shall be void from inception.Consolidated stamp duty for this Insurance Policy is paid by Demand Draft, vide Receipt/Challan noNO.LOA/ENF-1/CSD/34/2023/6045 dated
27/12/2023 as prescribed in Government of Maharashtra Order No. Mudrank-2017/CR.97/M-1, dated the 09th January 2018". Goods & Services Tax Registration No: 27AABCL5045N1Z8. GST for this invoice is
not payable under reverse charge basis. I/ We hereby declare that though our aggregate turnover in any preceding financial year from 2017-18 onwards is more than the aggregate turnover notified under sub-rule
(4) of rule 48, we are not required to prepare an invoice in terms of the provisions of the said sub-rule
Branch :leela business park, 6th flr, andheri - kurla rd, mumbai
Agent Name : HDFC BANK LTD For HDFC ERGO General Insurance Company Ltd.
Agent Code : 201587086428 Tel No. : 91-22-61606161
Duly Constituted Attorney
"For detailed policy terms and conditions please visit our website https://www.hdfcergo.com/download/policy-wordings."

e-Enrollment Form for coverage under Policy No. 2999204608551801000 offered to the customers of
HDFC BANK
Proposal No. : 2811 2062 8038 1100 000 Issuance Date : 01/04/2024
Period of Insurance : From 31/03/2024 10:07 hrs To 30/03/2025 Midnight
Invoice No. : 206280381100000 Premium Frequency : Single
MR. DHANASEKARAN S Proposer Name : Mr. Dhanasekaran S Policy Type : Individual
1/256-C AMMAN KOVILPATTI Virudhungar
HSN Code : 997133 Plan Type : Gold
VIRUDHUNAGAR, TAMIL NADU - 626005
Contact No : 97XXXXXXX1 PAN No.
Proposer’s GSTIN No :
Email ID : dhxxxxxxxxxxan@gxxxx.com
Details of the Persons Proposed to be Insured
Insured's Name Relation with policy Gender DOB Height Weight Nominee Name Nominee 1st Policy Sum CB Pre-existing
holder Relationship Inception Insured Amount disease
Dhanasekaran S Self Male 04/06/1992 156 60 Yamuna D Spouse 31/03/2024 500000 0 No
Go Green and Make a difference!! By choosing this option, only soft copy of Policy shall be delivered to your registered mail. The soft copy i s valid for lodging claims or any other
service needs. (If you require physical copy of your policy in future, please visit "Help" section on www.hdfcergo.com or contact our customer care)
Coverage Details
Coverage Details Coverage Details
In-Patient Hospitalisation Covered Pre-Hospitalization Medical Expenses Cover 60
Post-Hospitalization Medical Expenses Cover 90 Room Rent Per Day (Normal) 1% of Sum Insured,Max Rs. 3,000/-
Room Rent Per Day (ICU) 2% of Sum Insured Road Ambulance Cover Rs. 2,000/- per hospitalization
30 Day Waiting Period Applicable Waiting period for specified illnesses 24 Months
Waiting Period for Pre-existing Diseases 36 Months Day Care Procedures Covered
Domiciliary Hospitalization Covered Alternative Treatment Upto 50% of Sum Insured
1% of Sum Insured, max Rs.
Preventive Health Check-up Organ Donor Expenses Covered
2,000/- in a block of 3 years
10% for each claim free year, max
Cumulative Bonus Disease Capping None
50%
Restore Benefit Not Applicable Hospital Cash Rs. 500 per day, max 30 days
Premium Details (`)
Basic Premium (A) 6,151.00
Medical Underwriting Loading (B) 0.00
Total Premium (A+B) 6,151.00
Integrated Tax 18 % 1,107.00
Gross Premium 7,258.00
Payment Details
Premium Payment Options: Net Banking / Credit Card / Debit Card Premium Amount (Annual) Rs. 7258
Net Banking Transaction ID: 91124033100014 Transaction Date:
We will refund (Excess Premium / PPC reimbursement / Cancellation) directly into your account/ card which was used to pay premium for this policy.
Declaration & Warranty on behalf of all Persons Proposed to be insured

“I/We hereby declare, on my behalf and on behalf of all persons proposed to be insured, that the above statements, answers and/or particulars given by me are true and complete in all respects to the best of my
knowledge and that I/We am/are authorized to propose on behalf of these other persons.
I/We understand that the information provided by me will form the basis of the insurance policy, is subject to the Board approved underwriting policy of the insurance company and that the policy will come into
force only after full receipt of the premium chargeable.
I/We further declare that I/we will notify in writing any change occurring in the occupation or general health of the life to be insured/proposer after the proposal has been submitted but before communication of the
risk acceptance by the company.
I/We declare and consent to the company seeking medical information from any doctor or from a hospital who at anytime has attended on the life to be insured/proposer or from any past or present employer
concerning anything which affects the physical or mental health of the life to be assured/proposer and seeking information from any insurance company to which an application for insurance on the life to be
assured/proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
I/We authorize the company to share information pertaining to my proposal including the medical records for the sole purpose of proposal underwriting and/or claims settlement and with any Governmental
and/or Regulatory authority.”
Declaration & Warranty on behalf of Insurance Company
Note: The liability of the company does not commence until the acceptance of the proposal has been formally intimated to the insured and full premium has been realized by the company.
We are under no obligation to accept any proposal for insurance. The Proposer agrees that the receipt of the Proposal Form by HDFC ERGO General Insurance Company Limited along with the premium
payment does not tantamount to the acceptance of the Proposal for insurance by HDFC ERGO General Insurance Company Limited and does not result in a concluded contract of insurance. The acceptance
of the Proposal for insurance shall be at the Company's sole and absolute discretion and upon full realization of the premium payment .In the event of acceptance of the Proposal for insurance by HDFC ERGO
General Insurance Company Limited, such acceptance shall be specifically intimated to the Proposer by HDFC ERGO General Insurance Company Limited along with the date from which the insurance Cover
shall become effective. HDFC ERGO General Insurance Company Limited shall not be liable for any claim in respect of an event giving rise to a claim covered under the Policy of Insurance that has occurred
prior to policy issuance is not covered under this policy(Your proposal form will be considered after HDFCERGO General Insurance Company Limited receives premium payment.).
Fraud Warning: This policy shall be voidable at the option of the Company in the event of mis-representation, mis-description or non-disclosure of any material particulars by the Proposer. Any person who,
knowingly and with intent to fraud the insurance company or any other person, files a proposal for insurance containing any false information, or conceals or the purpose of misleading, Information concerning
any fact material thereto, commits a fraudulent insurance act, which will render the policy voidable at the sole discretion of the insurance company and result in a denial of insurance benefits
Anti-Rebating Warning: As per Section 41 of the Insurance Act 1938,as amended, the practice of rebating is prohibited, as follows: No person shall allow or offer to allow, either directly or indirectly, as an
inducement to any person to take out o r renew or continue an insurance policy in respect to any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or
any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published
prospectus or tables of the insurer. Violation of Section41 of the Insurance Act 1938, as amended, shall be punishable with a fine which may extend to`10Lakhs.

e-Enrollment Form for coverage under Policy No. 2999204608551801000 offered to the customers of
HDFC BANK
General Insurance Declaration

I have understood the Coverage & Benefits payable under the plan and the insurance plan opted by me is on a voluntary basis and as per my requirement. I have read and understood the features of policy and
agree to proceed with my application. HDFC Bank has arrangement with 6 Non-Life Insurance Companies - HDFC ERGO General Insurance Co. Ltd., Bharti AXA General Insurance Co. Ltd., Bajaj Allianz General
Insurance Co. Ltd., Aditya Birla Health Insurance Co. Ltd., Max Bupa Health Insurance Co. Ltd. & HDFC Ergo Health Insurance Ltd. relevant details of the products have been disclosed to me.
Disclaimer : Proposal Form and Policy Schedule have been generated basis details authenticated b y proposer / insured on Online Platform of HDFC ERGO General Insurance Co Ltd. For Changes if any, kindly
visit URL https://www.hdfcergo.com/customer-care/customer-support.html and register.
Certificate of Insurance

Policy No.:2811206280381100000 This card is for identification purpose only.
Valid From: 31/03/2024 Renewal Date: 30 March
Card has to be presented to the Network Service Provider at the time of admission/ availing
cashless hospitalization o r any other services. Insurance claim will be processed in accordance
Insured Name Member ID Date Of Birth Gender
with the policy term & conditions. Card does not guarantee cashless hospitalization or any other
service. For more details and updated list of Network Service Provider please refer our website or
Dhanasekaran S 2024410038936998 04/06/1992 Male call our call centre. This card is valid till the time policy is active.
Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234
Email : healthclaims@hdfcergo.com
Processing Centre : HDFC ERGO General Insurance Company Ltd. 5th
floor,Tower 1, Steller IT Park, C-25,
Sector-62,Noida-201301.
Website : www.hdfcergo.com

Mr. Dhanasekaran S 1/256-C AMMAN KOVILPATTI Virudhungar VIRUDHUNAGAR, 626005 Tamil Nadu Contact No: 97XXXXXXX1 Date: 01/04/2024

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Mr. Dhanasekaran S 1/256-C AMMAN KOVILPATTI Virudhungar VIRUDHUNAGAR, 626005 Tamil Nadu Contact No: 97XXXXXXX1 Date: 01/04/2024

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HDFC ERGO General Insurance Company Limited 2811206280381100000

We welcome you to be a part of our family!

For HDFC ERGO General Insurance Company Ltd.

HDFC ERGO General Insurance Company Limited

Dear MR. Dhanasekaran S,

For HDFC ERGO General Insurance Company Ltd.

Payment Details : 91124033100014 , Bank Name :BIZDIRECT

Applicable only to HDFC BANK Customers

Duly Constituted Attorney

HDFC Group Health Insurance

Declaration & Warranty on behalf of all Persons Proposed to be insured

HDFC Group Health Insurance

General Insurance Declaration

HDFC ERGO General Insurance Company Limited 1

Customer Service No : 022 - 6234 6234 / 0120 - 6234 6234

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